High recurrence rate of eczema herpeticum in moderate/severe atopic dermatitis -TREATgermany registry analysis.
Atopic dermatitis
herpes simplex
registry
Journal
Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG
ISSN: 1610-0387
Titre abrégé: J Dtsch Dermatol Ges
Pays: Germany
ID NLM: 101164708
Informations de publication
Date de publication:
Dec 2023
Dec 2023
Historique:
received:
11
10
2022
accepted:
09
07
2023
pubmed:
10
10
2023
medline:
10
10
2023
entrez:
10
10
2023
Statut:
ppublish
Résumé
Eczema herpeticum (EH) is a disseminated skin infection caused by herpes simplex virus in atopic dermatitis (AD) patients. The frequency of EH and the clinical features of EH patients have not yet been investigated in a larger cohort. We sought to investigate the TREATgermany cohort, a multicenter, non-interventional clinical registry of moderately to severely affected AD patients in Germany. Baseline characteristics of patients included between December 2017 and April 2021 were compared between patients without, single, and multiple EH. Of the 893 patients, 195 (21.8%) had at least one EH. Of the 195 patients with EH, 107 had multiple EH (54.9%), representing 12.0% of the total study population. While there were no differences in demographic characteristics, previous treatment, and disease scores at enrollment (itch, IGA, oSCORAD, EASI), patients with EH had more frequent atopic comorbidities and sensitizations to house dust mite, food, and mold. TREATgermany registry data suggest a high prevalence and recurrence rate of EH, while there appears to be no specific clinical phenotype, besides an increase in allergies, to identify EH patients in the daily routine.
Sections du résumé
BACKGROUND
BACKGROUND
Eczema herpeticum (EH) is a disseminated skin infection caused by herpes simplex virus in atopic dermatitis (AD) patients. The frequency of EH and the clinical features of EH patients have not yet been investigated in a larger cohort.
METHODS
METHODS
We sought to investigate the TREATgermany cohort, a multicenter, non-interventional clinical registry of moderately to severely affected AD patients in Germany. Baseline characteristics of patients included between December 2017 and April 2021 were compared between patients without, single, and multiple EH.
RESULTS
RESULTS
Of the 893 patients, 195 (21.8%) had at least one EH. Of the 195 patients with EH, 107 had multiple EH (54.9%), representing 12.0% of the total study population. While there were no differences in demographic characteristics, previous treatment, and disease scores at enrollment (itch, IGA, oSCORAD, EASI), patients with EH had more frequent atopic comorbidities and sensitizations to house dust mite, food, and mold.
DISCUSSION
CONCLUSIONS
TREATgermany registry data suggest a high prevalence and recurrence rate of EH, while there appears to be no specific clinical phenotype, besides an increase in allergies, to identify EH patients in the daily routine.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1490-1498Informations de copyright
© 2023 The Authors. Journal der Deutschen Dermatologischen Gesellschaft published by John Wiley & Sons Ltd on behalf of Deutsche Dermatologische Gesellschaft.
Références
Langan SM, Irvine AD, Weidinger S. Atopic dermatitis. Lancet. 2020; 396:345-360.
Augustin M, Girbig G, Kis A, et al. Inpatient care for skin diseases in Germany: multi-source analysis on the current and future health care needs. J Dtsch Dermatol Ges. 2021;19(5):25-53.
Traidl S, Werfel T, Traidl-Hoffmann C. Atopic eczema: pathophysiological findings as the beginning of a new era of therapeutic options. Handb Exp Pharmacol. 2022;268:101-115.
Fölster-Holst R. The role of the skin microbiome in atopic dermatitis - correlations and consequences. J Dtsch Dermatol Ges. 2022;20(5):571-577.
Traidl S, Roesner L, Zeitvogel J, Werfel T. Eczema herpeticum in atopic dermatitis. Allergy. 2021;76(10):3017-3027.
Bieber T. Atopic dermatitis: an expanding therapeutic pipeline for a complex disease. Nat Rev Drug Discov. 2022;21(1):21-40.
Traidl S, Freimooser S, Werfel T. Janus kinase inhibitors for the therapy of atopic dermatitis. Allergol Select. 2021;27;5:293-304.
Klein B, Treudler R, Simon JC. JAK-inhibitors in dermatology - small molecules, big impact? Overview of the mechanism of action, previous study results and potential adverse effects. J Dtsch Dermatol Ges. 2022;20(1):19-24.
Werfel T, Heratizadeh A, Aberer W, et al. Update “Systemic treatment of atopic dermatitis” of the S2k-guideline on atopic dermatitis. J Dtsch Dermatol Ges. 2021;19(1):151-168.
Fleming P, Drucker AM. Risk of infection in patients with atopic dermatitis treated with dupilumab: A meta-analysis of randomized controlled trials. J Am Acad Dermatol. 2018;78(1):62-69.
Eichenfield LF, Bieber T, Beck LA, et al. Infections in dupilumab clinical trials in atopic dermatitis: a comprehensive pooled analysis. Am J Clin Dermatol. 2019; 20:443-456.
Werfel T, Irvine AD, Bangert C, et al. An integrated analysis of herpes virus infections from eight randomized clinical studies of baricitinib in adults with moderate-to-severe atopic dermatitis. J Eur Acad Dermatol Venereol. 2022;36(9):1486-1496.
Reich K, Teixeira HD, de Bruin-Weller M, et al. Safety and efficacy of upadacitinib in combination with topical corticosteroids in adolescents and adults with moderate-to-severe atopic dermatitis (AD Up): results from a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2021;5;397(10290):2169-2181.
Guttman-Yassky E, Teixeira HD, Simpson EL, et al. Once-daily upadacitinib versus placebo in adolescents and adults with moderate-to-severe atopic dermatitis (Measure Up 1 and Measure Up 2): results from two replicate double-blind, randomised controlled phase 3 trials. Lancet. 2021; 5;397(10290):2151-2168.
Simpson EL, Sinclair R, Forman S, et al. Efficacy and safety of abrocitinib in adults and adolescents with moderate-to-severe atopic dermatitis (JADE MONO-1): a multicentre, double-blind, randomised, placebo-controlled, phase 3 trial. Lancet. 2020;25;396(10246):255-266
Traidl S, Kienlin P, Begemann G, et al. Patients with atopic dermatitis and history of eczema herpeticum elicit herpes simplex virus-specific type 2 immune responses. J Allergy Clin Immunol. 2018; 141(3):1144-1147.
Siegels D, Haufe E, Heinrich L, et al. Status report on the atopic dermatitis registry TREATgermany. Allergol Select. 2021;5:274-286.
Helmert C, Siegels D, Haufe E, et al. Perception of the coronavirus pandemic by patients with atopic dermatitis - Results from the TREATgermany registry. J Dtsch Dermatol Ges. 2022;20(1):45-57.
Heratizadeh A, Haufe E, Stölzl D, et al. Baseline characteristics, disease severity and treatment history of patients with atopic dermatitis included in the German AD Registry TREATgermany. Eur Acad Dermatol Venereol. 2020;34(6):1263-1272.
Gerbens LAA, Apfelbacher CJ, Irvine AD, et al. TREatment of ATopic eczema (TREAT) Registry Taskforce: an international Delphi exercise to identify a core set of domains and domain items for national atopic eczema photo- and systemic therapy registries. Br J Dermatol. 2019;180(4):790-801.
Williams HC, Schmitt J, Thomas KS, et al. The HOME Core outcome set for clinical trials of atopic dermatitis. J Allergy Clin Immunol. 2022;149(6):1899-1911.
Schmitt J, Spuls P, Boers M, et al. Towards global consensus on outcome measures for atopic eczema research: results of the HOME II meeting. Allergy. 2012;67(9):1111-1117.
Schmitt J, Spuls PI, Thomas KS, et al. The Harmonising Outcome Measures for Eczema (HOME) statement to assess clinical signs of atopic eczema in trials. J Allergy Clin Immunol. 2014;134(4):800-807.
Wollenberg A, Zoch C, Wetzel S, et al. Predisposing factors and clinical features of eczema herpeticum: a retrospective analysis of 100 cases. J Am Acad Dermatol. 2003; 49(2):198-205.
Seegräber M, Worm M, Werfel T, et al. Recurrent eczema herpeticum - a retrospective European multicenter study evaluating the clinical characteristics of eczema herpeticum cases in atopic dermatitis patients. J Eur Acad Dermatol Venereol. 2019;34(5):1074-1079.
Bork K, Brauninger W. Increasing incidence of eczema herpeticum: analysis of seventy-five cases. J Am Acad Dermatol. 1988;19(6):1024-1029.
Beck LA, Boguniewicz M, Hata T, et al. Phenotype of atopic dermatitis subjects with a history of eczema herpeticum. J Allergy Clin Immunol. 2009;124(2):260-269.
Peng WM, Jenneck C, Bussmann C, et al. Risk factors of atopic dermatitis patients for eczema herpeticum. J Invest Dermatol. 2007;127(5):1261-1263.
Lübbe J, Pournaras CC, Saurat JH. Eczema herpeticum during treatment of atopic dermatitis with 0.1% tacrolimus ointment. Dermatology. 2000;201(3):249-251.
Reitamo S, Rustin M, Ruzicka T, et al. Efficacy and safety of tacrolimus ointment compared with that of hydrocortisone butyrate ointment in adult patients with atopic dermatitis. J Allergy Clin Immunol. 2002;109(3):547-555.
Wollenberg A, Wetzel S, Burgdorf WH, Haas J. Viral infections in atopic dermatitis: pathogenic aspects and clinical management. J Allergy Clin Immunol. 2003;112(4):667-674.
Gao PS, Rafaels NM, Mu D, et al. Genetic variants in TSLP are associated with atopic dermatitis and eczema herpeticum. J Allergy Clin Immunol. 2010;125(6):1403-1407.e4.
Bin L, Edwards MG, Heiser R, et al. Identification of novel gene signatures in patients with atopic dermatitis complicated by eczema herpeticum. J Allergy Clin Immunol. 2014;134(4):848-855.
Bin L, Malley C, Taylor P, et al. Whole genome sequencing identifies novel genetic mutations in patients with eczema herpeticum. Allergy. 2021;76(8):2510-2523.
Gao PS, Rafaels NM, Hand T, et al. Filaggrin mutations that confer risk of atopic dermatitis confer greater risk for eczema herpeticum. J Allergy Clin Immunol. 2009; 124(3):507-513.
Gao PS, Leung DY, Rafaels NM, et al. Genetic variants in interferon regulatory factor 2 (IRF2) are associated with atopic dermatitis and eczema herpeticum. J Invest Dermatol. 2012;132(3 Pt 1):650-657.
Bin L, Kim BE, Brauweiler A, et al. Staphylococcus aureus alpha-toxin modulates skin host response to viral infection. J Allergy Clin Immunol. 2012;130(3):683-691.e2.